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HOSPITAL/HEALTH
CARE CHAPLAINCY
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THE
MAGNIFICAT After Easter 2004 the Statue of Our Lady of Walsingham was taken to a variety of secular sites including a school, prison, army barracks and, for the first time, one of our Hospital Trusts. The Royal Wolverhampton Hospitals NHS Trust welcomed this visit warmly and over 250 people took part in the Day which began with Mass and ended with a Service of Healing. Below is the text of the lecture delivered during the visit to the hospital.
When in doubt steal somebody else's title, which is what I have done. Though as Fr. Philip so kindly pointed out to me before I began, I'm not stealing, but rather 'developing'. The Magnificat, (and, in passing, my very secular NHS computer keeps underlining the word in red as 'non recognisable' which says more about the computer than it does about the Magnificat), presents us with certain themes which apply to Healthcare. And Healthcare presents us with certain issues and challenges which apply to and are reflected in the Magnificat. Theology is about, in Tillich's words, correlating the two. Let’s have a go and see where we arrive.
'MY SOUL; AND MY SPIRIT REJOICES' A Human Being is physiology, mind, emotion, spirit, personality, history, story, individuality, autonomy, soul. Medicine and resultant healthcare is in danger of losing this breadth of what it is to be a Human Being To some degree this loss is both understandable and, indeed, to be welcomed. Medicine is a science and like all science, both in theory and practice, is generalising, thematising, de-individualising, technologically interventionist, much of what we know as Healthcare necessarily and successfully follows this medical model. This is particularly true and to be welcomed in times of critical, life threatening episodes. What the patient requires in such instances is, perhaps after anointing if there is time, high tech. intervention which deals exclusively with the physiological problem. If such intervention does not happen or is not successful, the patient will have no existence this side of the grave, to which spiritual identity and consequent care is either relevant or effective. Such focussed intervention cannot, however, be the total or the end, because healthcare in its true sense is about the whole person, not just his or her physiology. It is about emotion, hope, fear, spirit, love, about the patients' emotional hinterland and relationships. At some stage the wider model of Healthcare must take over. Healthcare is Body, Soul and Spirit. At this point, I want to defend the concept 'soul'. In a recent book, Fr. Tom Wright, the Bishop of Durham, contends that the word 'soul' has become misleading, leading as it potentially does, to false quantitative conceptions and consequent questions such as, 'Where is the soul in a human being?' and, 'When and how does the soul leave the body at or after death?' Whereas, I would, myself, fully agree with the danger of a false objectivising of the soul, which has led, both in past and present, to some absurd answers to such objective questions, I am equally aware that to abandon soul language altogether, as regards a full description of human beings, might well be to 'throw the baby out with the bath water'. I do not, with respect, to the Bishop, believe that to replace the concept of human souls with that of human persons is at all adequate. For me, persons emphasise the solidarity and continuity of every individual with the whole of the human race, a necessary emphasis, but, not, I would contend the whole description of what we mean by a human being. The concept of the human being as soul seems, to me, to safeguard the necessary emphasis, in our analysis of what it is to be human, on the unique individuality and mystery of each one of us, as individual creatures related to, and sustained by God. Almighty God, is, as originator and sustainer of our individual identity and mystery, the guarantor of our individuality, soul language is an irreplaceable 'shorthand' of that fact, we abandon it at our peril. 'Rejoices in GOD MY SAVIOUR' Having said that Healthcare is wide, beyond the mere physiological we need to balance that, with the emphasis that for an 'incarnational' religion, salvation and Saviourhood, which in some sense causes and sustains salvation, cannot just be spiritual. Salvation is as much about the body as it is about the soul. We need to see Creation as ongoing, striving to perfection and fulfilment in God’s good eschatological time. The treating, palliating, curing, of physical and emotional illness is to be viewed, by the believing healthcare practitioner, of whatever sort, in this perspective. This perspective has importance for both practitioner and patient. For the former it allows him or her to live with seeming failure. For the latter it allows him or her the space and opportunity to come to terms with frustrated hope and disappointment. 'THE LOWLINESS OF HIS HANDMAIDEN' Sickness brings you low. It humbles you, it weakens you. It makes you vulnerable. It threatens your story, it challenges starkly your expectations of the future. It, in some sense fixes you, stitches you up you might say, both literally and metaphorically. In some sense it makes you as vulnerable and as fixed as our Lord; you become the victim of events and circumstances, many of them seemingly totally random and certainly brutally secular. This vulnerability is shared by all those in the patients' emotional and relational hinterland, healthcare practitioners included. 'And
his mercy is on THOSE WHO FEAR HIM We are not in Medicine and Healthcare - ARROGANT OPTIMISTS. Or we shouldn’t be if we are so tempted. We need to know our limitations, our God given boundaries, our proneness to ethical parameters and consequent judgements. We need as in all human activity to recall that Creation involves an evaluative component from, whatever we mean by the word its 'beginning'. Even if we de-temporalise the word it, at least, continues to mean present, depth and fullness, and eschatological end. 'and God saw that it was good' It is vitally important that ethical debate and evaluation is at the centre of healthcare, and that the challenge to, and the training for, that debate and evaluation be included in the training of any healthcare professional. Such inclusion needs to be on more than those, somewhat negative grounds of preventing damaging litigation, it needs rather to be on the more positive ground of being right in itself and on its own terms. 'He
has PUT DOWN THE MIGHTY FROM THEIR SEAT AND HAS EXALTED THE HUMBLE
AND MEEK Equity and Equality in medicine and Healthcare provision. What a vision. What an ideal. But how realistic in practice? What do we mean by Equity? It’s one of those concepts and words, of which there are many, which we envisage and articulate, unaware of their ambiguity or their proneness to at least two meanings. (eg unique, natural, normal). In the NHS context for example, do we mean by equity that all the people on the NHS books, with all possible diseases and ailments are put into the pot of limited resources and each receives quantitatively an equal share of resource? Or is that absurd? It’s certainly one model. Or, do we mean by equity a concept and practice which involves more of the evaluative and the prioritising, so that in practice patients suffering from the same medical problem are prioritised as regards their access to treatment, or that various medical problems and those suffering from them are per se given priority over other medical conditions? At first sight a more realistic concept of equity. But beware we have opened up a Pandora’s Box. On what grounds are people suffering from the same condition prioritised? Social and economic usefulness for example. Who prioritises medical conditions. The Government? Social Consensus? If so how is it obtained 'objectively', and from whom, and by whom? The problem is that we all emotionally adhere to the quantitative model of equity, equal shares for all, whereas, rationally we know it simply won't do and will, in the end, satisfy nobody. Therefore you have to introduce a qualitative and evaluative element into equity both in theory and practice. One way in which the introduction of this evaluative element has been attempted, is through the application of the theory of Quality Adjusted Life Years. A proposed medical intervention is judged in terms, not just of quantitative life expectancy, but also in terms of predicted quality of life. As a general theory this might sound plausible but, as with all theories, the problems arise with the application. The basic problem is, of course, that patients, as individual people, will, in and through that individuality, hold different views, both in theory and practice, regarding the precise and acceptable balance between longevity and quality of life. For example, a particular patient with a terminal illness, might have a particular life event, eg marriage of his daughter, for which he wishes to stay alive. He will, therefore, be prepared to undergo highly invasive and quality of life diminishing treatment simply to physically survive, and when he has, will let go. Another patient will go for limited longevity but, owing to the lack of aggressive invasive treatment, he or she will have, with palliation, a reasonable quality of life to the end. The point is, that broad theories, theoretically useful as they are, do not, in application, tend to respect the wide diversity of patient choice. What about Private Healthcare, should you be able to buy it if you can afford it? Does private Healthcare and its profit to Trusts which provide it subsidise public healthcare provision in those Trusts. If it does, should it? If you can afford to buy a transplantable organ, perhaps from the Third World, should you be allowed to? Where is world wide equity? 'PROMISED TO OUR FOREFATHERS ABRAHAM AND HIS SEED FOR EVER'. Medicine and Healthcare as all human activity inherits from the past and creates for future generations. Important that we take both perspectives seriously and responsibly. We need to be grateful for, and properly use the skills and insights we have gained from the past discarding, with respect and honour, those which have been superseded. We need also in developing medical and healthcare insights and practice to always, particularly in ethical judgement of them, be asking the teleological and consequential questions as regards their implications for future generations. This doesn’t in itself make us purely pragmatic and perhaps rather cynically consequentialist in our analysis of what it is to make an ethical judgement. It is possible, indeed, I would maintain desirable, to combine principle and consequence in ethical analysis and judgement in medicine as in any other human activity. What we do now affects future human beings. We need to take that into account. One particular focus of this teleological ethical issue, is that of genetic therapy. Somatic therapy is about genetically treating a particular focussed condition in a particular patient from whom free and informed consent has been obtained. No problems there, provided the treatment is safe. Stem gene therapy, is however, a little more problematic. The problem arises, because decisions are being made, which will affect the lives of the yet unborn , who cannot, by definition, give consent to decisions which have affected them. There is one other theme of the Magnificat, which is not particularly enshrined in one particular verse, but rather underlies not only the Magnificat, but also the event of which it was a part. That theme is Consent. The Magnificat reflects the free and joyous consent of Mary to the will of Almighty God. Consent is a central ethical and practical issue in Healthcare. Traditionally consent has to be free and informed. So much for the theory, practice is rather more difficult. If a patient has, for example, been treated for a long time by a particular consultant and his or her team, is the patient in any sense sufficiently free to give valid consent if that consultant, or any member of his or her team, asks that patient if she or he is willing to become part of a research trial? Is there sufficient 'emotional' and 'dependency' freedom? Do we have in place in the NHS, sufficient translation facilities to ensure that information for potential research subjects is effective and fully informative? Are the consent forms which patients have to sign, devoid of medical shorthand and buzz words? Well there we are the lines of the Magnificat spark off for me connections, correlations, with issues in and features of medicine and healthcare. But we can't and shouldn’t leave it there. We need to remember that these are lines spoken by Our Lady. She
not only said them, she presumably experienced their depth and meaning,
she 'personified' them. I see Mary almost every day in my chaplaincy work. She's disguised, and, as Our Lord is disguised in both male and female, so is Mary, but, let's concentrate on the female. She
is the mother on the Neo Natal Unit. In all of these situations and more, Mary is present as Pieta holding in some sense her child, dead or alive in her arms. That’s the image with which I leave you. And we say: "Hail,
Mary, Full of Grace; the Lord is with thee: Amen" Links to:
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This page was created on 27 May 2004. Additional notes added 11 June 2004 |
